specialty practice series

Best Practices in Nursing Care

for Hospitalized Older Adults
From The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing

Issue Number SP5, Revised 2018 Editor-in-Chief: Sherry A. Greenberg, PhD, RN, GNP-BC
Managing Editor: Robin Coyne, MSN, RN, AGACNP-BC
NYU Rory Meyers College of Nursing

Assessment of Spirituality in Older Adults:

FICA Spiritual History Tool
By: Tami Borneman, MSN, RN, CNS, FPCN
Division of Nursing Research & Education, City of Hope National Medical Center
and Hospice and Palliative Nurses Association
WHY: Older adults often need to find a way to cope with serious illnesses and end of life issues while re-evaluating life and spirituality. Research has
shown that patients rely on their religion to help them cope with their illnesses and want their clinicians to ask about their spiritual concerns. The
National Quality Forum (2006) and The National Consensus Project for Quality Palliative Care (2013) include spiritual care as one of eight clinical
practice guidelines. Hence, clinicians need to incorporate a spiritual history into routine patient care.

BEST TOOL: The FICA Spiritual History Tool (FICA) (Puchalski, 1996) was developed in collaboration with primary care providers as a guide for
clinicians to incorporate open-ended questions regarding spirituality into a standard comprehensive history. FICA pocket cards and a demonstration
on how to perform a spiritual history may be found at The George Washington Institute for Spirituality and Health website, www.gwish.org.

TARGET POPULATION: Any older adult facing illness. As people age, they often reflect on the past. Spirituality, however defined by the patient,
is often a component of reminiscing that may reinforce meaning and value to a person’s life.

VALIDITY AND RELIABILITY: Preliminary clinical evaluation (n=76; mean age 57) of the feasibility and usefulness of the FICA was
conducted as part of a larger National Cancer Institute funded study (B. Ferrell, P.I.). Content analysis was used to capture themes from FICA open-
ended questions along with descriptive data from the single item FICA quantitative measure that asked patients to rate the importance of faith/belief
in their life on a 0 (not important) to 5 (very important) scale. The mean score of 8.40 indicated that spirituality was important to patients, and data
confirmed that the FICA was effective for assessing several dimensions of spirituality based on correlation with spirituality indicators in the Quality
of Life (QOL) Tool - Spiritual Domain (Borneman et al., 2010).
Bremault-Phillips and colleagues (2015) used the FICA tool to integrate spirituality into routine patient care in three inpatient units (hospice, tertiary
palliative care, and geriatric assessment) within a hospital setting. Nurses became more aware of the need to recognize and respond to spiritual needs.
They also found that providing spiritual care facilitated connection with their patients, improved patient-centered care, and improved job satisfaction
through meeting patient needs.
A systematic review of instruments used to take a spiritual history was performed by Luchetti and colleagues (2013). They looked at over 2000
articles and after excluding those not meeting criteria, 25 instruments for taking a spiritual history were selected. Results revealed that the FICA tool
was one of five that scored the highest in the final analysis.

STRENGTHS AND LIMITATIONS: The FICA provides clinicians with a quick and easy means to conduct a spiritual history. Preliminary data
from one hospital and one setting found the FICA to be clinically useful. Further research is still needed.

FOLLOW UP: Follow up assessment involves addressing all the issues in the FICA at every regularly scheduled visit. This enables the clinician to
make the appropriate referrals (e.g. to pastoral counseling) depending on the findings.

MORE ON THE TOPIC:

Best practice information on care of older adults: www.ConsultGeri.org.
Borneman, T., Ferrell, B., & Puchalski, C. (2010). Evaluation of the FICA tool for spiritual assessment. Journal of Pain and Symptom Management, 40(2), 163-173.
Bremault-Phillips, S., Olson, J., Brett-MacLean, P., Oneschuk, D., Sinclair, S., Magnus, R., Weis, J., Abbasi, M., Parmar, J., & Puchalski, C. M. (2015). Integrating spirituality
as a key component of patient care. Religions, 6(2), 476-498.
Lucchetti, G., Bassi, R., & Lucchetti, A. (2013). Taking spiritual history in clinical practice: a systematic review of instruments. Explore, 9(3), 159-170.
National Quality Forum. (2006). A national framework and preferred practices for palliative and hospice care quality. Washington, DC: National Quality Forum.
National Consensus Project for Quality Palliative Care. (2013). Clinical practice guidelines for quality palliative care (3rd ed.). Available from
https://www.nationalcoalitionhpc.org/ncp-guidelines-2013.
Puchalski, C. (2006). Spiritual assessment in clinical practice. Psychiatric Annals, 36(3), 150-155.
Puchalski, C., & Romer, A.L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137.

Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety for not-for-profit educational purposes only, provided that
The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing is cited as the source. This material may be downloaded and/or distributed in electronic
format, including PDA format. Available on the internet at www.hign.org and/or www.ConsultGeri.org. E-mail notification of usage to: nursing.hign@nyu.edu.
 FICA Spiritual History Tool (Puchalski, 1996)
Clinician Questions Patient Responses

F FAITH AND BELIEF

• Do you consider yourself spiritual or religious?

•D
 o you have spiritual beliefs that help you cope
with stress?

If the patient answers “No,” the health care provider might ask,

• What gives your life meaning?

Sometimes patients respond with answers such as family, career, or nature.

I IMPORTANCE

•W
 hat importance does your faith or belief have in
your life?
•H
 ave your beliefs influenced how you take care of
yourself in this illness?
•W
 hat role do your beliefs play in regaining your health?

C COMMUNITY

• Are you part of a spiritual or religious community?

• Is this of support to you and how?

• I s there a group of people you really love or who are

important to you?

Communities such as churches, temples, and mosques, or a group of like-minded friends can serve as strong support systems
for some patients.

A ADDRESS IN CARE

•H
 ow would you like me, your healthcare provider, to
address these issues in your healthcare?

Available at www.gwish.org

Reprinted with permission from Christina Puchalski, MD, FACP

Executive Director, The George Washington Institute for Spirituality and Health

specialty practices series
Best Practices in Nursing Care
for Hospitalized Older Adults
From The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing
A series provided by The Hartford Institute for Geriatric Nursing,
NYU Rory Meyers College of Nursing
EMAIL: Nursing.HIGN@nyu.edu HARTFORD INSTITUTE WEBSITE: www.hign.org
CLINICAL NURSING WEBSITE:
www.ConsultGeri.org